| NPI | 1588334544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904013309) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 111050) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2024-01-03 |